A recent prospective study suggests that aprepitant may lead to faster response than desloratadine in patients who have pruritus due to treatment with an epidermal growth factor receptor tyrosine kinase inhibitor (EGFR-TKI). These study results were reported in the journal Cancer.
This multicenter, double-blind phase 2 trial (ClinicalTrials.gov Identifier: NCT02646020) enrolled adults with histologically confirmed locally advanced or metastatic non-small cell lung cancer (NSCLC) who experienced an initial case of moderate to severe pruritis while receiving EGFR-TKI therapy.
Patients were randomly assigned 1:1 to aprepitant or desloratadine for 4 weeks of treatment. Patients also received placebo on certain days of their respective treatment protocols. Response rate was the primary outcome, defined as the proportion of patients with a reduction in pruritus intensity of 50% or greater, based on visual analog scale (VAS) scores, after 1 week of therapy.
A total of 130 patients were recruited for the study, with a median age of 63 years. Mean baseline VAS scores for pruritus were 6.35 (95% CI, 5.89-6.82) in the aprepitant arm and 5.94 (95% CI, 5.56-6.32) in the desloratadine arm (P =.17).
The final analysis included 57 patients in the aprepitant arm and 50 in the desloratadine arm. Following 1 week of treatment, both groups showed significant decreases in VAS scores with therapy (P <.001). However, the decrease was more significant in the aprepitant group (57.9% compared with 28.0% in the desloratadine arm; P =.002). After 4 weeks of treatment, 73.7% in the aprepitant arm responded to treatment, compared with 56.0% in the desloratadine arm (P =.06).
The mean time to response with aprepitant was 13.39 days (95% CI, 11.08-15.70), which was shorter than the mean of 16.67 days (95% CI%, 14.19-19.13) with desloratadine (P =.04). Recurrence of pruritus was reported in 18.8% of patients in the aprepitant arm, compared with 6.8% in the desloratadine arm, but this did not reflect a significant difference (P =.33).
Reported adverse events (AEs) were all grade 1 or 2. The most frequent treatment-related AEs were constipation (8.1%) and anorexia (8.1%) in aprepitant arm. In the desloratadine arm, the most frequent treatment-related AEs were dry mouth (11.9%), dizziness (8.5%), and fatigue (6.8%).
The study investigators reported that nearly 15% of patients in the aprepitant arm experienced recurrence during weeks 2 to 4, and indicated optimal aprepitant treatment duration should be explored in further research. “Despite the limitation, our study showed that patients responded better and faster to aprepitant in managing EGFR‐TKI‐induced pruritus than desloratadine, without significantly increasing adverse events,” the investigators concluded in their report.
Zhou T, Zhang Y, Ma Y, et al. Comparison of aprepitant versus desloratadine for EGFR-TKI‐induced pruritus: a randomized phase 2 clinical trial. Cancer. 2022;128(22):3969-3976. doi:10.1002/cncr.34474